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HomeMy WebLinkAboutX2021-2368 - Permit Application (2)1=rnt Form Worksheet for Combo Building & Solar Permit A plicationp F_ Comm'I f— Residential City of Newport Beach -Building Division x2�2G Z J f� 0 NOTE: PLAN CHECK FEES DUE AT TIME OF SIIRMITTAI j uilding F_ Grading rDrainage [Elec r'Mech Plum Cu yd cutF_ Cu Yd Fill � Project Address (Not mailing address) C Flood r Fire (- Liq (- Landslide F_N/A Floor Suite No .... .... 1_ Q_._ (���`� i d�_ Description of Work Use Const Type I ' �cL lCb rC ` # StoriesF7# Units (if Res) Valuation $ 3/ o� New/Add SF� Remodel SF�— Garage/New/Add Material/Labor l OWNER'S NAME Last CUY't741U Spvk. First Owner's Address Owner's E-mail Address t 745_ jkea �P ( City -Zjk t45 RtApr StateFc zip q__i53P TelephoneF777777 APPLICANT'S NAME Last ' First Applicant's Address Applicant's E-mail Address ... ._....... .___ - 1?�[CtUr rtnr........�8t QAQ--YeS•�ori<#,`GN_, City iyc ri5tvtov -0 State 1444 4' Zip l_ 2), Telephone �M 6 009 I�i 3 ARCHITECT/DESIGNER'S NAME Last �2gt r First R�yu fro Lic. No. L° 3 C6 ,9 Architect/Designer's Address 3 Lie , Architect/Designer's E-mail Address t City ��(/{� I q �al� ... �eG.CLL State .. Zip I ,i_(, 7 Telephone %/1 � his a Ji2e ENGINEER'S NAME Last r4; Z First Lic. No. _5�'(2 Engineer's Address . D (f - ,E— s SOG. , Engineer's E-mail Address 4- + _!N • .,t—e. /(,R /4e . 1. ity Qfo —e -State I N' Zip 72667 Telephone RACTOR'S NAME/COMPANY 1AAA Lic. No. 783 4 E3 Class. hr's Address Contractor's E-mail Address �i5e»v✓cv State f Zip `/2,e-3,., Telephone jS/_ SETBACKS FRONT PERMIT NO. XZpZA - 23 I7y SETBACKS RIGHT PLAN CHECK NO. Z—O7-f - f DEVELOPMENT NO PLAN CHECK FEES $ _ _